New Client Form

* Your privacy is important to us. All information you provide is considered confidential.

Today's Date:

Appointment Date & Time:

Date

Time

Owner Information

Owner Name *

First

Last

Co-Owner Name

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Work Phone

Cell Phone

Co-Owner Cell

Owner's Email *

Co-Owner Email

How did you hear about us? *

Referral (specify below)
Web
Other (specify below)

Emergency Contact Info:

In the event of an emergency and YOU / CO-OWNER cannot be reached, who may we contact for your pet?

Contact Name *

First

Last

Phone Number *

Other Phone

How is this person related to you?

What if any additional information do we need regarding this contact?

From time to time we post pet pictures on our webpage and our Facebook page. May we choose your pet? *

Yes
No

Pet Information

(If you have additional pets, please complete this information for each pet)

Pet's Name

Species:

Dog
Cat
Other (Specify Below)

Breed

Color

Age / Date of Birth

Sex

Male
Male (neutered)
Female
Female (spayed)

What veterinary clinic may we contact to obtain records for your pet?

Veterinary Clinic Phone

Does your pet have medical insurance?

Yes
No

PAYMENT FOR SERVICES

El Gato Veterinary Hospital does not bill. We require payment in full at the time services are rendered. We accept, Visa, Mastercard, Discover, American Express, cash, CareCredit. In the case of a pet emergency, we require a deposit at the time of admission and the additional payment at the time of discharge. *

I have read, understand, and agree to these conditions.

Signature *

Clear Signature

Name

Address

El Gato Veterinary Hospital
15748 Los Gatos Blvd.
Los Gatos, CA 95032

Numbers

Call or Text: 408-356-2181
Fax: 408-356-5790

For 24 hour emergency services, please visit MedVet Campbel (408) 371-6252.

Temporary Hours of Operation

M-F: 9:00 am - 5:00 pm
Saturday: Closed
Sunday: Closed

Even though we’re located in Los Gatos, CA, we’re happy to provide veterinary care to pets in Campbell, San Jose, Santa Clara, Sunnyvale, Mountain View, Morgan Hill, Boulder Creek, Felton, Cupertino, Monte Sereno, Saratoga, and Scotts Valley! Looking for the best veterinary care in Northern California? Come see the team at El Gato Veterinary Hospital.